HOME-BASED PSYCHIATRIC TREATMENT: 2000-2005
Ferentinos P, Zeikou E, Milonaki T, Kalabogia K, Fitsiou P, Tsitsopoulou M, Sakellaropoulos P Mental Health Institute for Children and Adults, Athens, Greece
Introduction
Home-based psychiatric treatment (HBPT), as applied by the Mental Health Institute for Children and Adults (MHICA), dates back to the 1970s. It was introduced by Professor P.Sakellaropoulos.
HBPT’s basic principle is that treatment is better provided in patients’ home, when possible.
Goals
HBPT’s main goal is to avoid hospitalization, which often brings about regression, self-depreciation, stigmatization, family’s guilt and induces patients’ persecutory fantasies. Compliance, responsibility and active participation in therapy are, thus, facilitated.
In parallel, the patient’s family is involved through consultation sessions. The patient and his family are dealt with as a whole even though the symptoms are not the same.
Another main goal of HBPT is continuity in psychiatric care after the crisis intervention. When the acute phase is over, therapy is encouraged to continue in an integrated medical and psychosocial treatment program in MHCIA.
Therefore, HBPT is not an isolated activity but it is incorporated in a treatment network, which combines medical and psychosocial therapies (drug therapy, psychotherapy, family therapy, Day Center services), in an attempt to respond continuously and cohesively to psychotic patients’ various needs.
Therapeutic team
The therapeutic team consists of mental health professionals of different specialties (psychiatrists, psychologists, nurses, social workers).
Eligible patients
HBPT is indicated for:
acute psychiatric patients
patients returning home after a long or short term hospitalization
outpatients, who have never been hospitalized (Mobile Units of Fokida and Evros)
stabilized patients with mobility problems
There can be combinations and modifications of technique according to psychopathology, family support, and risk issues.
Objective
This study presents findings regarding:
Patients considered eligible for HBPT (Intakes) between 2000 and 2005
Patients actually treated with HBPT between 2000 and 2005
Demographic Characteristics
71 patients
42 females (59.2%), 29 males (40.8%)
age 41.5 (±19.6) years
Marital Status | ||
N | % | |
Single | 54 | 76,1 |
Married | 8 | 11,3 |
Widowed | 5 | 7,0 |
Divorced | 2 | 2,8 |
Separated | 2 | 2,8 |
Total | 71 | 100,0 |
Lives With | ||
N | % | |
Family | 58 | 81,7 |
Relatives | 2 | 2,8 |
Alone | 11 | 15,5 |
Total | 71 | 100,0 |
Education | ||
N | % | |
Primary School (6 Y) | 7 | 9,9 |
Secondary School (9 Y) | 11 | 15,5 |
Likeio (12 Y) | 19 | 26,8 |
University (16-18 Y) | 26 | 36,6 |
Technical University (15 Y) | 2 | 2,8 |
Postgraduate Education (16+ Y) | 4 | 5,6 |
Illiterate | 1 | 1,4 |
Special Education | 1 | 1,4 |
Total | 71 | 100,0 |
Profession | ||
N | % | |
Businessman | 4 | 5,6 |
Public Servant | 10 | 14,1 |
Private Sector Employee | 4 | 5,6 |
Unspecialised Worker | 1 | 1,4 |
Retired | 9 | 12,7 |
Student | 8 | 11,3 |
Housewife | 5 | 7,0 |
Unemployed | 29 | 40,8 |
Total | 70 | 98,6 |
Missing | 1 | 1,4 |
Total | 71 | 100,0 |
Occupational Status | ||
N | % | |
Full-Time | 12 | 16,9 |
Part-Time | 5 | 7,0 |
None | 21 | 29,6 |
None Due To Psychiatric Disorder | 33 | 46,5 |
Total | 71 | 100,0 |
Living Area
Frequency | Percent | |
Athina | 14 | 19,7 |
Kallithea | 6 | 8,5 |
Faliro | 5 | 7,0 |
N.Irakleio | 4 | 5,6 |
N.Smirni | 4 | 5,6 |
Ag.Dimitrios | 3 | 4,2 |
Glifada | 3 | 4,2 |
Halandri | 3 | 4,2 |
Kaisariani | 3 | 4,2 |
Piraias | 3 | 4,2 |
Zografou | 3 | 4,2 |
Filothei | 2 | 2,8 |
Menidi | 2 | 2,8 |
Moshato | 2 | 2,8 |
Argiroupoli | 1 | 1,4 |
Dionisos | 1 | 1,4 |
Drosia | 1 | 1,4 |
Aigaleo | 1 | 1,4 |
Elliniko | 1 | 1,4 |
Koridallos | 1 | 1,4 |
Nikaia | 1 | 1,4 |
N.Psihiko | 1 | 1,4 |
Perama | 1 | 1,4 |
Peristeri | 1 | 1,4 |
Tavros | 1 | 1,4 |
Voula | 1 | 1,4 |
Vrillisia | 1 | 1,4 |
Xanthi | 1 | 1,4 |
Total | 71 | 100,0 |
HBPT intakes per year (2000-2005)
| N | % |
2000 | 9 | 12,7 |
2001 | 24 | 33,8 |
2002 | 12 | 16,9 |
2003 | 9 | 12,7 |
2004 | 7 | 9,9 |
2005 | 10 | 14,1 |
Total | 71 | 100,0 |
HBPT intakes per month (2000-2005)
Intakes per month | ||
N | % | |
January | 7 | 9,9 |
February | 5 | 7,0 |
March | 8 | 11,3 |
April | 8 | 11,3 |
May | 7 | 9,9 |
June | 7 | 9,9 |
July | 7 | 9,9 |
September | 4 | 5,6 |
October | 5 | 7,0 |
November | 7 | 9,9 |
December | 6 | 8,5 |
Total | 71 | 100,0 |
Diagnosis
Diagnosis | N | % |
Psychotic disorder | 43 | 60,6 |
Affective disorder | 14 | 19,7 |
Personality disorder | 9 | 12,7 |
Anxiety disorder | 2 | 2,8 |
Conduct disorder | 1 | 1,4 |
Dementia | 1 | 1,4 |
Mental disorder due to somatic illness | 1 | 1,4 |
Total | 71 | 100,0 |
Clinical characteristics
49 acute patients (69 %)
Duration of disease 7.5±9.7 years (0-38 y)
18 patients (25.4%) had no former psychiatric treatment
24 patients (33.8%) had no drug therapy in the past
22 patients (31%) had 1-8 hospitalisations in the past
Outcome of former psychiatric treatment | ||
N | % | |
Improved | 6 | 11,3 |
Remained stagnant | 35 | 66,0 |
Deteriorated | 6 | 11,3 |
Interrupted | 5 | 9,4 |
Total | 52 | 98,1 |
Missing | 1 | 1,9 |
Total | 53 | 100,0 |
B. PATIENTS ACTUALLY TREATED WITH HBPT(2000-2005)
Demographic characteristics
49 patients
29 females (59.2%), 20 males(40.8%)
age 39.6 (±17.9) years
Marital status | ||
N | % | |
Single | 38 | 77,6 |
Married | 5 | 10,2 |
Widowed | 2 | 4,1 |
Divorced | 2 | 4,1 |
Separated | 2 | 4,1 |
Total | 49 | 100,0 |
Lives With | ||
N | % | |
Family | 42 | 85,7 |
Relatives | 1 | 2,0 |
Alone | 6 | 12,2 |
Total | 49 | 100,0 |
Occupational status | ||
N | % | |
Full-time | 9 | 18,4 |
Part-time | 5 | 10,2 |
None | 10 | 20,4 |
None due to psychiatric disorder | 25 | 51,0 |
Total | 49 | 100,0 |
Diagnosis
Diagnosis | ||
N | % | |
psychotic disorder | 28 | 57,1 |
affective disorder | 11 | 22,4 |
personality disorder | 6 | 12,2 |
anxiety disorder | 2 | 4,1 |
conduct disorder | 1 | 2,0 |
mental disorder due to somatic illness | 1 | 2,0 |
Total | 49 | 100,0 |
Clinical characteristics
32 acute patients (65.3%)
Duration of disease 7.6±9.8 years
11 patients (22.4%) had no former psychiatric treatment
16 patients (32.7%) had no drug therapy in the past
14 patients (28.6%) had 1-3 hospitalisations in the past
Outcome of former psychiatric treatment | ||
N | % | |
improved | 6 | 12,2 |
remained stagnant | 21 | 42,9 |
deteriorated | 6 | 12,2 |
interrupted | 4 | 8,2 |
Total | 37 | 75,5 |
Missing | 12 | 24,5 |
Total | 49 | 100,0 |
HBPT Features
Drug therapy: 46 patients (93.9%)
Psychotherapy: 49 patients (100%)
Parental counseling: 15 patients (30.6%)
Number of Therapists | ||
N | % | |
1 | 8 | 16,3 |
2 | 26 | 53,1 |
3 | 15 | 30,6 |
Total | 49 | 100,0 |
HBPT course
22 patients (44.9%) finalized treatment after 19.6 (±13.8) months;
19 patients (38.8%) dropped out after 2.3 (±2.4) months;
7 patients (14.3%) are still on treatment.
HBPT outcome
In total, 71.4% of patients improved and 28.6% remained stagnant.
CONCLUSION
Profile of the patient presenting for HBPT:
female,
around 40 years old,
single,
living with her family,
well-educated,
unemployed,
currently unoccupied,
psychotic,
disease onset before 7.5 years
in the acute phase
not hospitalised in the past
not improved with former treatment